Impact of child mortality and fertility preferences on fertility status in rural Ethiopia.

OBJECTIVES To determine the effects of child mortality and fertility preference on fertility status in rural Ethiopia. DESIGN Case-referent where the cases were women with number of children ever born alive was less than five and controls were women with number of children ever born alive greater or equal to five. SETTING Butajira rural health project study base which is a field epidemiologic laboratory found 35 Kms south of the capital city of Ethiopia, Addis Ababa run by the Department of Community Health of Tikur Anbessa Medical Faculty. MAIN OUTCOME MEASURES Fertility status measured by number of children ever born alive; death of a child or an infant is a predictor. SUBJECTS A total of 219 women with number of children ever born alive less than five and 899 women with number of children ever born alive greater or equal to five were included in the study. RESULTS Child mortality affected number of children ever born alive significantly (OR= 7.39, 95% CI: 4.62, 9.08). As the number of children died increased proportionally, there is a proportional increase in the risk of higher fertility (X2 for trend 4.92, d.f =4, p-value 0.02). Number of children desired before marriage, desire for more children and sex preference were not associated with increased fertility in this study. Of all the socio-demographic and reproductive variables, later age at first marriage and first birth showed lower number of children ever born alive with (OR= 1.82, 95 % CI: 1.24, 2.83) and (OR= 3.08, 95 % CI: 2.03, 4.68) respectively. Breast-feeding duration of more than six months showed association with less number of children ever born alive (OR= 1.92, 95% CI: 1.30,2.80). CONCLUSION The study finding implies high fertility status is strongly associated with child death and hence measures that curb child mortality are believed to decrease fertility status besides promoting child survival.